Podcast
Questions and Answers
Which of the following is a risk factor for prostate cancer?
Which of the following is a risk factor for prostate cancer?
The majority of prostate cancers occur in the transition zone.
The majority of prostate cancers occur in the transition zone.
False
What is the best imaging technique to visualize prostate cancer?
What is the best imaging technique to visualize prostate cancer?
TRUS
Prostate cancer treatment may involve _______ for patients with low-grade tumors who have a long life expectancy.
Prostate cancer treatment may involve _______ for patients with low-grade tumors who have a long life expectancy.
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Match the treatment of prostate cancer with its description:
Match the treatment of prostate cancer with its description:
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What is the normal PSA level considered to be indicative of prostate health?
What is the normal PSA level considered to be indicative of prostate health?
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The prostate biopsy is typically done without any prior requirements such as taking antibiotics.
The prostate biopsy is typically done without any prior requirements such as taking antibiotics.
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What is the primary reason for conducting a digital rectal exam (DRE)?
What is the primary reason for conducting a digital rectal exam (DRE)?
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In cases of prostatitis, clinical symptoms may include fever, chills, and ______.
In cases of prostatitis, clinical symptoms may include fever, chills, and ______.
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Match each term with its description:
Match each term with its description:
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At what age should prostate cancer screening typically begin for men?
At what age should prostate cancer screening typically begin for men?
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Prostate cancer is the second leading cause of cancer deaths in men.
Prostate cancer is the second leading cause of cancer deaths in men.
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What imaging technique is typically used in conjunction with a prostate biopsy?
What imaging technique is typically used in conjunction with a prostate biopsy?
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Prostatitis can be classified as ______ or chronic.
Prostatitis can be classified as ______ or chronic.
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Match the following cyst types with their descriptions:
Match the following cyst types with their descriptions:
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Which of the following is NOT considered a symptom of Benign Prostatic Hyperplasia (BPH)?
Which of the following is NOT considered a symptom of Benign Prostatic Hyperplasia (BPH)?
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Acute prostatitis typically presents with well-defined symptoms such as fever and chills.
Acute prostatitis typically presents with well-defined symptoms such as fever and chills.
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What age range is prostate cancer screening recommended to cease?
What age range is prostate cancer screening recommended to cease?
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Prostate calcifications are more common with ______ age.
Prostate calcifications are more common with ______ age.
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Which diagnostic test is NOT specific for prostate cancer?
Which diagnostic test is NOT specific for prostate cancer?
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Study Notes
Prostate Abnormalities
- Prostate abnormalities are a significant health concern in men.
- Screening, diagnosis and management strategies are crucial.
Topic Outline
- Prostate cancer screening
- Digital rectal exam (DRE)
- Prostate-Specific Antigen (PSA)
- Serum Acid Phosphatase
- Prostate biopsy
- Normal variants of the prostate
- Inflammatory processes of the prostate
- Cysts of the male pelvis
- Benign Prostatic Hyperplasia (BPH)
- Prostate Cancer
Digital Rectal Exam (DRE)
- A physical exam to check for prostate abnormalities.
- Typically begins between ages 40-50, depending on risk factors.
- Assess for any palpable lesions or general prostate enlargement.
- Used with PSA to determine further evaluation needs.
- TRUS (transrectal ultrasound) may be used to follow-up.
Prostate Cancer Screening Tests
- Used to detect prostate cancer in asymptomatic men at an early stage, for early intervention to improve treatment outcomes.
- Allows for curative treatment in most men.
- Screening should start at age 50 (40 if family history).
- Includes annual DRE and PSA tests.
- Serum acid phosphatase test is also used, but screening ends at age 75.
Serum Acid Phosphatase
- An enzyme secreted by the prostate, normally found in semen.
- Prostate dysfunction can result in detectable levels in the bloodstream.
- Also produced by liver, spleen, blood cells, and bone marrow.
- Not specific, meaning it can indicate other conditions besides prostate issues.
Prostate Specific Antigen (PSA)
- A tremendous advance in prostate cancer management and diagnostics.
- An enzyme secreted by prostate ducts.
- Helps in liquefying semen.
- Normal levels are below 4ng/mL.
- Elevated levels can indicate cancer, though some men with BPH or inflammation may also have normal levels.
- Testing should be ordered before DRE in some cases.
Prostate Biopsy
- Typically done at the time of TRUS (transrectal ultrasound)
- Can be cancelled if the results of the biopsy are negative.
- Pre-biopsy considerations include antibiotics and anticoagulant discontinuation.
- Similar to other core biopsy procedures.
- Requires informed consent.
- Local anesthetic is used.
- Multiple samples of prostate tissue are often collected.
- Patients typically stay in the department for about one hour after the procedure.
- 18 or 14 gauge needle typically used.
Normal Variants of Prostate Gland
- Benign Ductal Ectasia:
- More common with advancing age.
- Prostate tissue atrophies and ducts dilate.
- Seen as 1-2mm tubular structures on ultrasound.
- May present as a hypoechoic mass.
- Prostate Calcifications:
- More common with age.
- Appear as bright, echogenic foci on ultrasound.
- Sometimes present with shadowing or twinkle artifact.
Inflammatory Processes of Prostate Gland
- Prostatitis is inflammation of the prostate and seminal vesicles, either acute or chronic.
- Acute Prostatitis:
- Presents with typical inflammatory symptoms (fever, chills, pain, dysuria).
- Ultrasound role is limited by severe pain and difficulty with TRUS/DRE.
- Ultrasound appearance can mimic carcinoma.
- Can present as a hypoechoic gland with abnormal vascularity.
- Possible abscess formation may be present as an anechoic mass.
- Chronic Prostatitis:
- Associated with conditions like chlamydia or mycoplasma as well as no apparent cause.
- Presents with non-specific symptoms such as dysuria, frequency, urgency, hematospermia, pain.
- Appearance may include focal masses of variable echogenicity, ejaculatory duct calcifications, capsular thickening, dilated periprostatic veins, and distended seminal vesicles.
Cysts of the Male Pelvis
- Prostatic utricle cysts:
- Small pouch on posterior side of prostatic urethra.
- Often appear midline, tear-drop shaped.
- Mullerian duct cysts:
- Remnants of Mullerian duct, never contain sperm.
- Often appear tear-drop shaped, pointed towards verumontanum.
- Ejaculatory duct cysts:
- Cystic dilation of ejaculatory duct.
- Contain sperm.
- Typically associated with infertility.
- Seminal vesicle cysts:
- Remnants of Wolffian duct.
- Can be large.
- Often requires aspiration.
Benign Prostatic Hyperplasia (BPH)
- Benign enlargement of prostate gland, common finding in older men.
- Symptoms may include hesitancy, starting and stopping of urination, frequent urination, oliguria, and/or hematuria.
- Sonographic appearance includes a larger gland, specifically an inner (transition zone) gland enlargement.
- Potential for calcifications of the gland, as well as for cysts to be present.
- TURP could cause a large defect in the gland to be seen on imaging.
Prostate Cancer
- Most common cancer in men; second leading cause of cancer deaths in men (after lung cancer)
- Typically affects males over 50 years of age.
- Locations:
- 70% in peripheral zone, 20% in transition zone, 10% in central zone.
- Clinical Symptoms:
- Symptoms can include frequency, hesitancy, starting/stopping of urination, urgency, and weak stream.
- Sonographic Appearance:
- 30-40% of prostate cancers undetectable by ultrasound imaging.
- Biopsy required if DRE or PSA suspicious.
- Most hypoechoic, but some can be isoechoic or hyperechoic.
- Increased vascularity visible via Doppler interrogation.
- Treatment:
- Watchful waiting for low-grade tumors, often based on 10-year life expectancy.
- Radical prostatectomy (surgical removal), potentially leading to infertility and incontinence.
- Radiation therapy, external beam, or brachytherapy (implanted radiation seeds).
- Palliative therapy to manage pain and other symptoms.
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Description
Explore the critical aspects of prostate abnormalities, including screening techniques and diagnosis. This quiz covers important topics such as the Digital Rectal Exam (DRE), Prostate-Specific Antigen (PSA), and various conditions affecting the prostate. Learn about the management strategies for prostate health and the significance of early detection.
